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Background

Primary immune deficiencies (PID) are genetic disorders resulting in recurrent infections.
Immunoglobulin replacement therapy in PID patients can be achieved intravenously (IVIG)
or subcutaneously (SCIG) with similar efficacy and safety profiles but with different
resource use and associated costs.

Methods

SCIG and IVIG options for immunoglobulin replacement therapy in adult PID patients
were compared in a cost-minimization model over three years of treatment. The model
focused on direct medical costs for infusion supplies and personnel. A three-year
budget impact model assessed the economic impact on the healthcare system of switching
from IVIG to SCIG for PID patients of the BC Central Transfusion Registry. Sensitivity
analyses were performed for both models to measure the effect of different modalities
of IVIG treatment and of the proportion of patients switching from IVIG to SCIG.

Results

The cost-minimization model estimated SCIG treatment cost per patient over three years
at $1978 compared to $7714 for IVIG, resulting in savings to the healthcare system
of $5736, principally due to reduced hospital personnel costs. This figure varied
from $5035 to $8739 for different modalities of IVIG therapy. Assuming that 50% of
patients who received IVIG switched to SCIG, the budget impact model estimated cost
savings for the first three years at $1,307,894 or 37% of the personnel and supply
budget.

Conclusion

This study demonstrated that rapid push home-based SCIG was less costly than hospital-based
IVIG for immunoglobulin replacement therapy. This approach provides not only a beneficial
option from the patient perspective but also results in significant savings to the
healthcare system for immunoglobulin replacement therapy in adult PID patients in
a Canadian context.

Acknowledgments

Support for analyses and dissemination provided by CSL Behring Inc., Canada.